Expanding access to later abortion care in Maine: Improving in-state clinic referral systems

Access to later abortion care: Researchers have demonstrated that access to legal abortion care after the first trimester in the United States can be challenging and, at times, impossible for many people. In addition to state regulations that seek to curb access to later abortion (e.g. bans on later abortion surgical methods and gestational age [GA] bans), barriers to abortion care after the first trimester include a lack of trained providers, the need to travel longer distances to a clinic, and higher out-of-pocket costs. In order to minimize the logistical and financial burdens facing later abortion clients, it is essential that healthcare workers provide timely and appropriate referrals for clients who need to travel to receive services. 

Abortion landscape in Maine: In 2017, 31% of Maine’s counties did not have clinics that provided abortions,* and 24% of the state’s women lived in those counties.5 Maine does not mandate a specific gestational age limit on abortion services; instead, the state’s law imposes the federal standard that permits abortions up to the point of fetal viability. Abortions can be provided at or after viability if the pregnancy threatens the life or health of the pregnant person. In 2016, Maine had three freestanding ambulatory clinics (ASCs) and one hospital that provided abortion care after the first trimester, up to various gestational ages (Figure A; Table 1). During this time, no clear referral process existed among the clinics in Maine, which resulted in out-of-state referrals for many clients whose pregnancies exceeded the gestational age limits of the facilities or who had special health conditions. Researchers have found that traveling greater distances to abortion care is associated with a myriad of logistical and financial challenges, including delays in accessing care, greater difficulties getting to a clinic, and higher out-of-pocket costs. This brief describes a project spearheaded by the Later Abortion Initiative (LAI)† of Ibis Reproductive Health that sought to improve access to later abortion by piloting an in-state referral intervention for abortion providers in Maine.